LASIK and Systemic Contraindications
2007; Elsevier BV; Volume: 114; Issue: 5 Linguagem: Inglês
10.1016/j.ophtha.2007.02.009
ISSN1549-4713
Autores Tópico(s)Corneal surgery and disorders
ResumoI read with great interest the article by Cobo-Soriano et al1Cobo-Soriano R. Beltran J. Baviera J. LASIK outcomes in patients with underlying systemic contraindications.Ophthalmology. 2006; 113: 1118-1124Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar comparing the anatomic and functional results of LASIK in patients with underlying systemic diseases. There are some important points that should be addressed:1After reading this article, one may think that there is no significant systemic contraindication for LASIK and this procedure can be safely performed for all patients who were previously categorized in the “red light” list for refractive surgery, if the disease is quiescent—a dangerous concept. The authors have concluded that “LASIK can be performed effectively and safely in selected patients with stable and controlled systemic diseases with favorable postoperative anatomic and visual outcomes.” However, they did not completely explain their definition of selected patients with stable controlled systemic disease for each systemic disease (the practical specific inclusion and exclusion criteria for each systemic disease). For instance, in patients with rheumatoid arthritis what are the criteria that show that the disease is stable and controlled? Most connective tissue disorders such as systemic lupus erythematosis have wax and wane periods with apparently stable and controlled intervals that may mislead surgeons. Tear film tests are also necessary before any refractive surgery to rule out dry eye problems that are common in these patients.2In cases of diabetes mellitus, the authors did not mention if there was any sign of diabetic retinopathy before and after surgery.3Most of the patients were fairly young, with low amounts of refractive errors (approximately −3 diopters of myopia) and no significant astigmatism. Perhaps the authors’ meaning of selected patients is this group of myopic eyes.4Some patients with connective tissue disease or diabetes mellitus have a progressive destructive course; these young patients may have complex ocular manifestations and retinal disorders late in the disease course. For instance, diabetic patients may need some vitreoretinal surgery that is difficult to perform with a LASIK flap, which may even be lost by surgical trauma. A lot of patients with systemic disease need long-term corticosteroids that may cause cataracts at an earlier age in comparison to the normal population; IOL power calculation is more difficult and unpredictable after LASIK and may cause refractive surprise. Most of the authors’ patients were in their fourth decade of life, mostly in the pre-presbyopic age range. They may have acceptable near vision with the present myopia throughout their life. However, after LASIK they may soon need presbyopic glasses.In conclusion, I think the contraindications for LASIK should remain a red light for refractive surgery due to the unpredictable course of systemic diseases. I read with great interest the article by Cobo-Soriano et al1Cobo-Soriano R. Beltran J. Baviera J. LASIK outcomes in patients with underlying systemic contraindications.Ophthalmology. 2006; 113: 1118-1124Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar comparing the anatomic and functional results of LASIK in patients with underlying systemic diseases. There are some important points that should be addressed:1After reading this article, one may think that there is no significant systemic contraindication for LASIK and this procedure can be safely performed for all patients who were previously categorized in the “red light” list for refractive surgery, if the disease is quiescent—a dangerous concept. The authors have concluded that “LASIK can be performed effectively and safely in selected patients with stable and controlled systemic diseases with favorable postoperative anatomic and visual outcomes.” However, they did not completely explain their definition of selected patients with stable controlled systemic disease for each systemic disease (the practical specific inclusion and exclusion criteria for each systemic disease). For instance, in patients with rheumatoid arthritis what are the criteria that show that the disease is stable and controlled? Most connective tissue disorders such as systemic lupus erythematosis have wax and wane periods with apparently stable and controlled intervals that may mislead surgeons. Tear film tests are also necessary before any refractive surgery to rule out dry eye problems that are common in these patients.2In cases of diabetes mellitus, the authors did not mention if there was any sign of diabetic retinopathy before and after surgery.3Most of the patients were fairly young, with low amounts of refractive errors (approximately −3 diopters of myopia) and no significant astigmatism. Perhaps the authors’ meaning of selected patients is this group of myopic eyes.4Some patients with connective tissue disease or diabetes mellitus have a progressive destructive course; these young patients may have complex ocular manifestations and retinal disorders late in the disease course. For instance, diabetic patients may need some vitreoretinal surgery that is difficult to perform with a LASIK flap, which may even be lost by surgical trauma. A lot of patients with systemic disease need long-term corticosteroids that may cause cataracts at an earlier age in comparison to the normal population; IOL power calculation is more difficult and unpredictable after LASIK and may cause refractive surprise. Most of the authors’ patients were in their fourth decade of life, mostly in the pre-presbyopic age range. They may have acceptable near vision with the present myopia throughout their life. However, after LASIK they may soon need presbyopic glasses. In conclusion, I think the contraindications for LASIK should remain a red light for refractive surgery due to the unpredictable course of systemic diseases. Author replyOphthalmologyVol. 114Issue 5PreviewIn reference to Dr Mohammadpour’s comments, we point out the following: Full-Text PDF
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